tbuckley/cabot-search huggingface dataset:
Abstract 10153: Cord Blood Metabolite Signatures for Elevated Blood Pressure in Childhood and Adolescence
Authors: Mingyu Zhang, Tammy M Brady, Jessie P Buckley, Lawrence J Appel, Xiumei Hong, Guoying Wang, Liming Liang, Xiaobin Wang, Noel T Mueller
Journal: Circulation (2022)

Background: Risk factors for high blood pressure (BP) in children start in utero . Cord blood metabolites reflect exposures of the developing fetus to the in utero environment. No studies have examined whether cord blood metabolites are associated with BP in children. Objectives: To examine prospective associations of cord blood metabolites with systolic BP (SBP), diastolic BP (DBP), and risk of elevated BP in childhood and adolescence. Methods: We used data from the Boston Birth Cohort. Metabolites were measured in cord blood plasma samples collected at birth. SBP and DBP were measured at clinic visits between 3 to 18 years. We calculated BP percentiles per the 2017 American Academy of Pediatrics Clinical Practice Guideline. We examined associations of cord metabolites with SBP and DBP percentiles using linear mixed models and with elevated BP using mixed-effects Poisson regression. We used the False Discovery Rate (FDR) method to adjust for multiple comparisons. Results: Our study included 902 mother-child dyads (60% Black, 23% Hispanic, 45% female). Children were followed for a median of 9.2 (IQR: 6.7-11.7) years, and the median number of BP observations per child was 7 (IQR: 4-11). After FDR adjustment, 3, 94, and 22 metabolites were respectively associated with SBP, DBP, and risk of elevated BP; 2 metabolites (1-methylnicotinamide, dimethylguanidino valeric acid) were associated with all three outcomes, and 22 metabolites were associated with both DBP and risk of elevated BP. After multivariable adjustment, 48 metabolites remained significantly associated with DBP. Metabolites that showed the strongest associations with SBP, DBP, and risk of elevated BP included nucleotides (e.g., xanthosine, hypoxanthine, xanthine) and acylcarnitines (e.g., C6 and C7 carnitines), which represent fatty acid oxidation and purine metabolism pathways. Conclusions: In this predominantly urban, low-income, minority cohort, cord blood metabolites were prospectively associated with BP and risk of elevated BP from childhood to adolescence. Acylcarnitines and purine metabolism may be involved in the early life origins of hypertension. Cord metabolites may explain the intergenerational effects of in utero environments on BP in childhood and adolescence.
Abstract 10028: A Predictive Model of Iliofemoral Vascular Complications Following Transfemoral Transcatheter Aortic Valve Replacement
Authors: Ofir Koren, Vivek Patel, Raj Makkar, Robert Naami, Edmund Naami, Sharon Shalom Natanzon
Journal: Circulation (2022)

Objective: Design and validate a predictive model for iliofemoral vascular complications (IVC) following transfemoral-transcatheter aortic valve replacement (TF-TAVR). Background: IVC following TF-TAVR are common and associated with higher adverse events. However, there is no acceptable method to predict IVC. Methods: We used data from 3,706 TF-TAVR patients treated at Cedars-Sinai medical center between 2013-2021. We analyzed CT images of 516 matched patients to formulate a novel score index (Cedars-Sinai Index, CSI) and a predictive model and validated it on data of 609 consecutive patients. Patients with pre-procedural alternative access were excluded. Results: IVC occurred in 352 (9.1%) patients. The model design cohort includes 516 matched patients (by age, sex, and year of procedure) in a 2:1 ratio of control and IVC group. Sheath size, the sum of angles, number of curves, minimal lumen diameter (MLD), and sheath-to-femoral artery diameter ratio (SFAR) were significant predictors for IVC. The CSI formula consisting of the multiplication of the sum of angles and the number of curves divided by the MLD had an 84.3% sensitivity and 96.8% specificity (C-stat 0.936, 95% CI 0.911-0.959, p&lt;0.001) for predicting IVC. Setting CSI score &gt; 100 and SFAR &gt;1.0 increased overall accuracy and correctly predicted 97.7% of the complications. The validated model showed a 89.5% sensitivity, 98.9% specificity and 94.2% accuracy (C-stat 0.942, 95% CI 0.904-0.980, p&lt;.0001). Conclusion: Our proposed model is simple-to-use and accurately identifies patients at high risk for IVC. The model may be useful to implement in the pre-procedural planning of TAVR.
Abstract 10136: Tafamidis Patient Characteristics and Adherence: A Retrospective Analysis of German Statutory Health Insurance Data
Authors: Jason Kemner, Sepideh Attal, Mark Rozenbaum, Yong Chen, Jose Alvir, Sofia Schussler, Sebastian Barth
Journal: Circulation (2022)

Introduction: In February 2020, tafamidis became the first drug approved to treat adults with transthyretin amyloid cardiomyopathy (ATTR-CM) in Europe. However, the real-world treatment patterns of tafamidis 61 mg in Germany, including adherence rates, are not well studied. Methods: A non-interventional, retrospective, observational cohort study of German IQVIA TM longitudinal prescription data. Patients were statutory insured and received ≥1 prescription of tafamidis 61 mg between March 01, 2020 and August 31, 2021. Baseline characteristics were assessed descriptively. Treatment adherence was analysed using the modified medical possession ratio (mMPR) and proportion of days covered (PDC). Results: 989 patients received ≥1 tafamidis prescription, with a mean age of 77.8 years, 81.1% were male, and 22.9% were treated by a cardiologist (Table 1). Overall, there were 7,753 prescriptions for tafamidis 61 mg. Mean supply and follow-up duration (first to last prescription) were 9.1 months and 7.8 months, respectively. The most frequent prior and concomitant medications were loop diuretics (73.7% and 69.7%), beta blockers (67.5% and 57.0%), direct factor Xa inhibitors (54.7% and 53.3%), and statins (55.0% and 47.4%). 879 patients received ≥2 prescriptions. Among these, mean mMPR was 1.03 (93.4% had an adherence rate ≥80%) and PDC was 0.90 (87.1% had adherence rate ≥80%; Figure 1). Conclusions: Patients prescribed tafamidis 61 mg in Germany display very high adherence. Based on professional society recommendations and using real world data, we found opportunities for concomitant medication optimization in patients with ATTR-CM and treated with tafamidis.
Abstract 10047: A Case of Recurrent Miscarriages Due to Malignant Situational Cardioinhibitory Nerurocardiogenic Syncope Treated With Pacemaker Placement
Authors: Juan G Sierra, Laura Rojo Grajales, Carlos Matute-Martinez, Fernando Boccalandro
Journal: Circulation (2022)

Case Presentation: A 29- year-old G5A4 woman with history of seizure disorder presented with severe nausea and vomiting (N&amp;V) with transient loss of consciousness with twitching motor activity at 7-weeks' gestation. She had no post-ictal state, but a brief period of nausea and lethargy with a rapid return to baseline. Her medical history only included a diagnosis of seizure disorder since childhood treated with different anti-epileptic agents. She reported 4 first-trimester abortions secondary to reported intractable recurrent seizures during pregnancy accompanied by significant morning sickness. Her physical examination, laboratory tests, brain CT, EEG, EKG, and a trans-thoracic echocardiogram were unremarkable. Levetiracetam was started. While monitored in telemetry she had an episode of complete heart block for 8-seconds with ventricular standstill triggered by a bout of severe N&amp;V resulting in convulsive syncope. The diagnosis of situational cardioinhibitory malignant Neurocardiogenic Syncope (NS) was made. She underwent dual-chamber pacemaker implantation with complete resolution of her symptoms. After 6-months Levetiracetam was discontinued. Her pregnancy progressed to term delivering a healthy newborn. She remains asymptomatic 4 years after her pacemaker implantation. Discussion: Malignant NS is a type of neurally-mediated syncope that can lead to significant morbidity and occasional mortality. Situational syncope occurs when a vaso-vagal reflex occurs in response to a specific trigger, in the present case straining is associated with N&amp;V and has not been described with miscarriages. In this case, the pronounced vagal response to N&amp;V resulted in ventricular stand-still causing brain hypoperfusion and seizures, which are associated with miscarriage due to slower fetal heart rate, fetal hypoxia, fetal injury, placental hypoperfusion, placental abruption or trauma. To the best of our knowledge, this is the first case reported in the literature of recurrent miscarriages due to NS successfully treated with a pacemaker. Conclusions: Convulsive syncope can result in miscarriages and should remain in the differential diagnosis in patients presenting with suspected seizures associated with vaso-vagal triggers during pregnancy.
Abstract 10022: Marijuana Smoke or Vaporizer Aerosol Impairs Endothelial Function Regardless of Drying Regimen or Cannabinoid Profile
Authors: Poonam Rao, Natasha Goyal, Ronak Derakhshandeh, Christopher Havel, Peyton Jacob III, Matthew L Springer
Journal: Circulation (2022)

Introduction: Marijuana smoke and vaporizer aerosol adversely affect the cardiovascular system. Most US marijuana research has used research marijuana from the University of Mississippi supplied through the National Institute on Drug Abuse (NIDA). NIDA marijuana is dried at high temperature with maximum of 10% THC, but real-world material is gently dried and is ~20% THC. Because NIDA marijuana differs from what is currently used by the public in terms of THC content and drying regimen, skepticism regarding relevance to the real world is limiting the impact of results obtained from this material. Here, we validated the use of NIDA research marijuana in the study of vascular effects of cannabis. Hypothesis: Exposure to marijuana smoke or vaporizer aerosol, regardless of the cannabinoid profile or drying regimen, impairs endothelial function. Methods: We exposed groups of rats (n=8) to smoke or Volcano vaporizer aerosol from materials obtained from U Miss (Placebo (&lt;0.01% THC hot), 4.2% THC hot and gentle dried pair, 10% THC hot), from Biopharmaceutical Research Company (Castroville, CA) (20% THC gentle dried), commercial hemp with negligible THC content, and clean air. Exposure was pulsatile, 5s/min over 5 mins. Endothelial function was measured as flow-mediated dilation (FMD) and pre- vs. post-exposure FMD (10 and 30 mins after end of exposure) differences were analyzed. Results: We observed significant impairment of FMD after exposure to pulsatile smoke from marijuana with varied cannabinoid profiles and drying regimens (p≤.006), with no effect from clean air (p=.13). No significant recovery of FMD was observed in any group 30 mins after marijuana smoke exposure (p≥.32). Pulsatile exposure to aerosol generated from the same materials impaired FMD in all groups (p≤.001) except clean air (p=.23). Conclusions: Acute exposure to marijuana smoke/aerosol impairs endothelial function regardless of the drying regimens or the cannabinoid profile of the marijuana product.
Abstract 10063: Changes in Clinical Phenotype of Patients With ATTR Cardiac Amyloidosis During the Past 20 Years
Authors: Adam Ioannou, Rishi Patel, Yousuf Razvi, Aldostefano Porcari, Lucia Venneri, Ambra Masi, Paolo Massa, Daniel Knight, Ana Martinez-Naharro, Tushar Kotecha, Liza Chacko, Helen Lachmann, Ashutosh Wechalekar, Carol Whelan, Philip Hawkins, Julian D Gillmore, Marianna Fontana
Journal: Circulation (2022)

Introduction: Diagnostic and therapeutic advances have led to increased awareness of transthyretin cardiac amyloidosis (ATTR-CA). We sought to characterise the change in clinical phenotype of patients with ATTR-CA over the last 20-years. Methods: We studied 1967 patients diagnosed with ATTR-CA at the National Amyloidosis Centre (NAC) from 2002-2021. Results: Analysis by 5-year quartiles revealed a substantial incremental increase in patients diagnosed, with the most marked increases seen in wild-type ATTR. Increased diagnoses were accompanied by greater proportions of patients referred following bone scintigraphy and cardiac magnetic resonance imaging (3% vs 44% vs 67% vs 76%, P&lt;0.001). Over time, median duration of symptoms prior to diagnosis diminished from 36-months between 2002-2006 to 12-months between 2017-2021 (P&lt;0.001) and a greater proportion of patients had milder disease at the time of diagnosis across the 5-yearly quartiles (NAC stage 1: 34% vs 42% vs 44% vs 53%, P&lt;0.001). The latter was associated with more favourable echocardiographic parameters of structure and function, including an incremental decrease in interventricular septal thickness(18.0±3.8mm vs 17.2±2.6mm vs 16.9±2.3mm vs 16.6±2.4mm, P=0.01), which was associated with improved survival. The improved survival associated with the year of diagnosis remained significant when censoring at trial or disease modifying medication start date (2012-2016 vs. 2017-2021: HR=1.05, 95%CI[1.03-1.07], P&lt;0.001). Conclusions: Increased awareness and advances in cardiac imaging have been associated with a substantial increase in diagnosis of ATTR-CA and at a progressively earlier stage of the disease, which has contributed to improved survival in recent years. These changes may have important implications for initiation and outcome of therapy and urgently need to be factored into clinical trial design.
Abstract 10606: The Increase of Myocardial Echogenicity Using Intracardiac Echography During Radiofrequency Ablation is an Effective Ablation Indicator
Authors: Takanao Mine, Miho Sugitani, Takehiro Kogame, Ryo Kitagaki, Eiji Fukuhara, Masaharu Ishihara
Journal: Circulation (2022)

Introduction: The increase of myocardial echogenicity (iME) is sometimes observed by intracardiac echography (ICE) during radiofrequency ablation (RFA), and the phenomenon has also been reported as a predictor of steam pop. However, the mechanism of iME caused by RFA remains unclear. Methods: We retrospectively studied 112 consecutive patients (age 70±9 years, 74 male) who underwent cavotricuspid isthmus (CTI) ablation. The changes in myocardial tissue during RFA were observed using ICE in 5.3 ± 1.4 points in each patient. 415 out of 590 ablation points were evaluable with ICE, and the iME during RFA were classified into three degrees (grade I: no change, II: mild, III: high brightness) by three independent observers who did not know clinical data. The voltage of myocardial amplitude and the myocardial wall thickness before and after RFA, and the lesion size index (LSI) incorporating contact force were measured at all RFA points. Results: RFA points were classified into 128 grade I of iME, 150 grade II, and 137 grade III. The iME during RFA were associated with reduced voltage of myocardial amplitude (grade I -0.22±0.44mV, II -0.29±0.47mV, III -0.38±0.47mV, P=0.0147), decreased rate of the voltage (grade I -14%, II -25%, III -44%, P=0.0131), and higher LSI (grade I 4.5±0.8mV, II 4.7±0.8mV, III 4.8±0.8, P=0.0207) (Figure). The higher LSI was associated with the decreased rate of the voltage (P=0.0491), but not with the voltage change of myocardial amplitude. On multivariate analysis, the iME during RFA was independently associated with the decreased rate of the voltage (P=0.0214). The iME was not related to the change in myocardial wall thickness before and after RFA, ablation sites (near tricuspid annulus side, middle part, or inferior vena cava side), and morphology of cavo-tricuspid isthmus. No steam pop phenomenon was observed. Conclusions: The iME during RFA is related to the decrease in myocardial amplitude due to RFA, and possibly be an effective ablation indicator.
Abstract 10062: Statin Utilization in a Real-World Primary Prevention Cohort of Older Adults
Authors: Aaron J Walker, Jianhui Zhu, Floyd W Thoma, Oscar C MARROQUIN, Amber Makani, Aryan Aiyer, Martha Gulati, Salim S Virani, Steven Reis, Christie M Ballantyne, Suresh R Mulukutla, Anum Saeed
Journal: Circulation (2022)

Introduction: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Although the ACC/AHA guidelines recommend statins for primary prevention among various groups aged 40-75, the guidelines are less clear for older adults (&gt;75y). We investigated statin use in older adults without ASCVD events, stratified by risk category, in a large healthcare network. Methods: Inclusion criteria were adults aged 75-79, without CAD, PVD or ischemic stroke. Statin utilization, based on the ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%). Patients were categorized into using low and ‘moderate or high’ intensity statins. Cox regression models were used to assess hazard ratios for ASCVD events and mortality over ≈6 years. Results: Among 8114 patients aged 75-79, 86.8% were high risk and 46% of these patients were on any statin. Compared with those on moderate or high intensity statins, older high-risk patients not on any statin had a significantly increased risk of MI [HR 1.53 (1.25-1.87); p&lt;0.001] , stroke [HR 1.52 (1.17-1.96); p&lt;0.01] and mortality [HR 1.43 (1.24-1.64); p&lt;0.001] (Table 1). High risk older adults on no statin had a higher risk of MI compared to those high risk &lt;75y on no statin [HR 1.15 (1.02-1.29); p value for age interaction &lt;0.05]. Statin initiation probability for those without any statin at first healthcare interaction was ≈36% at 5 years. Conclusion: In a large healthcare network, 54% of high-risk primary prevention older adults were not on any statin and initiation remained low at 5 years. Lack of statin use was associated with increased ASCVD events and mortality in high-risk older adults. Given the benefits appreciated with statin use in this older population in contemporary practices, statin use may need to be more strongly considered for primary ASCVD prevention among high-risk older adults. Further studies are needed to assess the risk-benefit ratio.
Abstract 10035: COVID-19 and Cardiac Transplant Rejection - Coincidence or Not?
Authors: Crystal L Yan, Nina Thakkar Rivera
Journal: Circulation (2022)

Overlap between the histopathologic changes of acute rejection and viral myocarditis presents a diagnostic dilemma. A 34 year-old female with a past medical history of postpartum cardiomyopathy and subsequent orthotopic heart transplant in December 2019, presented for routine surveillance heart biopsy seven months post-transplant. Her AlloMap was elevated and AlloSure was uptrending, concerning for rejection. Ten days prior to presentation, she tested positive for COVID-19 via polymerase chain reaction (PCR) testing. Her symptoms were fatigue and mild headache for two weeks prior to diagnosis. She did not seek medical attention for her symptoms and received no COVID-19 specific treatment. Endomyocardial biopsy showed grade 2R acute cellular rejection. Her echocardiogram was unchanged with normal left ventricular ejection fraction and right ventricular function. SARS-CoV-2 levels were measured by PCR of ribonucleic acid (RNA) isolated from the biopsy specimen and were undetectable. The patient was treated with two short courses of high dose prednisone which eventually abated her transplant rejection. The patient remained positive on PCR testing for COVID-19 for the next six months. Chest x-ray and computed tomography for follow up after COVID-19 infection showed no evidence of pulmonary fibrosis or superinfection considering ongoing immunosuppression for rejection. Our patient illustrates a case of concomitant COVID-19 infection and presumed transplant rejection, raising the question of whether the findings seen on immunohistochemistry were truly rejection or instead an elevated immune response due to COVID-19 infection. Given that our patient had a predominance of CD3+ T cells and less CD68+ macrophages (the former being more prominent in acute cellular rejection and the latter being more prominent in COVID-19 myocarditis), we are inclined to believe the former.
Abstract 10093: Association Between B-Thalassemia and Atrial Fibrillation: Insights From the United States National Inpatient Sample
Authors: Wael Abdelmottaleb, Ahmed Maraey, Mustafa Ozbay, Hadeer Elsharnoby, Mahmoud Khalil
Journal: Circulation (2022)

Introduction: β-thalassemia (BT) disease requires a lifelong blood transfusion. Despite improved prognosis with transfusion and chelation therapy, the iron overload can predispose to atrial fibrillation (AF). We sought to study the impact of AF on BT patients through large database analysis. Methods: The study used the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) for 2016-2019. Adult BT admissions were included. BT admissions were identified using ICD-10 code (D56.1). Admissions were stratified according to AF presence. A series of multivariate logistic regression was performed to evaluate the impact of atrial fibrillation on BT and to account for potential confounders. Continuous variables were compared using Student t-test, and categorical variables were compared using ꭓ2 tests. Subgroup analysis according to sex was performed. Outcomes evaluated were in-hospital mortality and prolonged length of stay (LOS) ≥ 75th percentile. Results: A total of 17,150 admissions were included, of which 2,100 (12.2%) had an associated diagnosis of AF. Admissions with AF were older (72.1 vs 47.3, P&lt;0.001), white race (66% vs 41%), and more likely to have congestive heart failure (CHF), hypertension, valvular heart disease, and renal disease. BT was associated with higher AF prevalence than non-BT admissions across all age groups. AF was not associated with increased risk of in-hospital mortality in the general cohort nor increased LOS (adjusted odds ratio [aOR]: 1.36 [0.67-2.78], P=0.398, and 1.00 [0.78-1.29], P=0.997, respectively). In subgroup analysis, including only female admissions, AF was associated with increased in-hospital mortality (aOR: 2.73 [1.09-6.8], P=0.031) but not with prolonged LOS (P=0.218). Predictors of in-hospital mortality were age, CHF, and liver disease, while predictors of prolonged LOS were Diabetes Mellitus in addition to CHF and age. Conclusions: We reported significant findings. First, AF is more common in BT compared to the general population, irrespective of age. Second, AF was independently associated with increased mortality in BT females. Third, CHF, liver disease, diabetes, and increased age are poor outcome predictors.